New Lancet Series on breastfeeding

Substantial development in research on breastfeeding over the past three decades has been captured in a recent Lancet series on breastfeeding. Two papers in this series, summarised in this issue of Field Exchange, describe past and current global trends in breastfeeding, its short and long-term health consequences for the mother and child considering different contexts, the impact of investment in breastfeeding, the determinants of breastfeeding, and the effectiveness of promotion interventions. An editorial and two comments (one on the economics and one on infant formula marketing) also feature; highlights as follows.

Keith Hansen argues that breastfeeding makes for excellent economics and describes the various strategies the World Bank is undertaking regarding this, relating to both intervention delivery and policy environment (such as labour laws and maternity leave) (Hansen, 2016). McFadden et al spotlight the consequences of inappropriate promotion and marketing of infant formula with reference to the International Code for Marketing of Breastmilk Substitutes. It draws on six country case studies conducted by Save the Children which showed inadequate implementation and enforcement of the Code, despite the enactment of its provisions into law. A 2014 WHO report found that less than a quarter of 199 countries have a functioning Code implementation and monitoring system in place with evidence of violations, such as company influence of health professionals by offering incentives. An example of the strong coordination necessary comes from the Philippines post-typhoon. The authors consider that the omission of breastfeeding from the Millennium Development Goals was a lost opportunity that should not be repeated for the Sustainable Development Goals. Existing initiatives such as the Global Breastfeeding Advocacy Initiative and the Network for Global Monitoring and Support for Implementation of the International Code (NetCode) can help provide the strong leadership needed.

The Lancet editorial makes the point that, while the series is comprehensive and the most in-depth analysis to date, the message is not new. Despite the evidence, global progress on breastfeeding rates has stalled. The reasons women avoid or stop breastfeeding range from the medical, cultural and psychological to physical discomfort and inconvenience. There are consequences for child and maternal health. The editorial concludes that genuine and urgent commitment is needed from governments and health authorities to establish a new normal: where every woman can expect to breastfeed, and to receive every support she needs to do so.